Provider Appeals Specialist I

Provider Appeals Specialist

Location: Birmingham, AL

Work Schedule: This is an onsite position, working in the VIVA HEALTH corporate headquarters in Birmingham, AL.

Why VIVA HEALTH?

VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.

VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan, receiving at least a 4 out of 5 Star rating for 10 years in a row, and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.

Benefits

• Comprehensive Health, Vision, and Dental Coverage


• 401(k) Savings Plan with company match and immediate vesting


• Paid Time Off (PTO)


• 9 Paid Holidays annually plus a Floating Holiday to use as you choose


• Tuition Assistance


• Flexible Spending Accounts


• Healthcare Reimbursement Account


• Paid Parental Leave


• Community Service Time Off


• Life Insurance and Disability Coverage


• Employee Wellness Program


• Training and Development Programs to develop new skills and reach career goals


• Employee Assistance Program

See more about the benefits of working at Viva Health - https://www.vivahealth.com/careers/benefits

Job Description

The Provider Appeals Specialist is responsible for the intake of all appeals received from contracted and non-contracted providers in a timely and accurate manner. This role will assist in processing the intake of appeals from mail, email, fax and other electronic means and is responsible for ensuring appeals are entered correctly and timely into the department’s database system. This individual will assist in the coordination of a timely resolution according to federal and state guidelines and VIVA HEALTH policies and procedures. This position will also assist with intake of Medicare appeals and grievances received from members and non-contracted providers.

Key Responsibilities

• Record appeals in the department’s system(s) timely and accurately, ensuring all necessary documentation is uploaded with the case.


• Classify contracted and non-contracted provider appeals according to federal and state regulations, as well as internal and organizational policies and procedures.


• Route appeals to other departments as needed for investigation to resolve the cases.


• Route other incoming mail, email and faxes to the appropriate departments in a timely manner.


• Assist with recording Medicare appeals and grievances requests in the department’s system(s) timely and accurately, ensuring all necessary documentation is uploaded with the case.


• Be available to work 8 a.m. to 5 p.m. Monday through Friday at the Company’s corporate headquarters, plus overtime and weekends as required.

REQUIRED:

• High School Diploma or GED


• 1+ years' experience in managed care, health care customer service, or appeals and grievances


• Excellent written and verbal communication skills, interpersonal skills, organization skills, and the ability to handle multiple tasks


• Ability to carefully follow processes in sequential order


• Ability to meet established productivity, schedule adherence, and quality standards


• Attention to detail and ability to meet strict deadlines


• Ability to learn and use various computer platforms and ability to use applications of Microsoft Office


• Ability to use critical thinking skills to develop solutions to non-clinical issues using fact-based decision making


• Ability to work occasional planned and unplanned overtime to meet deadlines with minimal supervision

PREFERRED:

• Associate's Degree


• 1+ years' experience processing Medicare appeals and grievances


• Knowledge of Medicare regulations


• Experience with administrative and/or coordinator positions with exposure to protected health information (PHI)